Case Study: The “Serious Injury” Threshold

Lonnie Gates was rear ended by a truck owned by Sears, Roebuck and Co. and driven by Gene H. Longden. Under New York State’s no-fault insurance rule, a person injured in an automobile accident may recover for medical bills and other economic damages from the insurance company covering the vehicle they are riding in, or are hit by, regardless of who was at fault in the accident. This recovery is limited to economic damages up to fifty thousand dollars. The damages recovered from the insurance company are meant to replace the right to sue for damages unless the plaintiff suffers a “serious injury”.

Many cases involving the no-fault insurance rule revolve around the definition of “serious injury.” New York Insurance Law § 5102 [d] defines serious injury as “a personal injury which results in death; dismemberment; significant disfigurement; a fracture; loss of a fetus; permanent loss of use of a body organ, member, function or system; permanent consequential limitation of use of a body organ or member; significant limitation of use of a body function or system; or a medically determined injury or impairment of a non-permanent nature which prevents the injured person from performing substantially all of the material acts which constitute such person’s usual and customary daily activities for not less than ninety days during the one hundred eighty days immediately following the occurrence of the injury or impairment.” Therefore, in order to have a right to sue, a plaintiff who has been injured must claim that he has suffered a serious injury fitting into this definition.

rear end2.jpgGates sued, claiming that he had been seriously injured in the accident. The defendants, Longden and Sears, moved for summary judgment. To grant summary judgment,the court must determine that no questions of fact exist that must be decided by the jury. The defendants claimed that Gates did not suffer a serious injury and that, if the court found that he had, it was not caused by the accident in question. Gates cross-moved for summary judgment on the issues of liability, proximate cause and serious injury.

The Supreme Court, Onondaga County, denied the defendants’ motion for summary judgment, but the Appellate Division, Fourth Department reversed. The Appellate Court however only reversed the Supreme Court’s decision to deny summary judgment in part. The Appellate Court found that the Supreme Court did not err in using its discretion not to consider the affidavit of defendants’ expert who was a engineer and not a medical doctor. Because the Supreme Court did not consider this testimony, the defendants failed to meet their burden to prove that the injury was not caused by the accident and summary judgment was rightly denied on this point.

The court also ruled that the Supreme Court did not err in denying the defendants’ motion for summary judgment as to significant disfigurement. It found that it was a question for the jury whether a large scar on the lower back constitutes a significant disfigurement. A significant disfigurement is defined as a condition caused by an accident that can be seen “as unattractive, objectionable, or as the subject of pity or scorn.” The court also found that because Gates had missed six weeks of work while confined to his home following the injury, a case may exist for a significant injury based on a serious limitation.

For the case to go forward to trial, Gates must only provide evidence that there is a question as to whether his injuries fit within the definition of “serious injury” laid out in New York Insurance Law § 5102 [d]. The court’s decision in this case means that it is a question that must be decided by the jury at trial whether a large scar on the lower back, or six weeks of confinement and missed work, fall within the definition of serious injury.

Gates v Longden, 2014 NY Slip Op 05744

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